Reviewed by Christina Aungst, PharmD
Updated on July 14, 2022
Shaky hands (tremors) are a common problem that isn’t usually serious. Hand tremors can be caused by health conditions or medications.
Some examples of medications that can cause shaky hands include certain asthma inhalers, antidepressants, and immunosuppressants.
Talk with a healthcare provider or pharmacist about whether your medication might be causing shaky hands. They can come up with a plan to help you manage and ease your symptoms.
The good news is tremors caused by medications tend to go away after lowering your dose or stopping the medication that may be causing it. But this may not always be the right option. It’s important to discuss shaky hands with your healthcare provider before making any medication changes.
So, what causes shaky hands? And how do you know whether it’s a sign of a more serious condition? Read on to learn more about 10 medications that may cause hand tremors.
Shaky hands causes
The cause of shaky hands is sometimes difficult to pinpoint. Tremors may be genetic. They could also be the result of a brain injury — particularly an injury in the areas of the brain involved with controlling movement.
It’s possible to experience a tremor without having a health issue. But, in some people, shaky hands can be a symptom of the following medical conditions:
Alcohol use disorder (AUD)
Hyperthyroidism (overactive thyroid)
Hypoglycemia (low blood sugar)
Kidney or liver failure
Multiple sclerosis (MS)
Some medications may also cause shaky hands, which we’ll cover in more detail below.
Signs a medication may be causing your hand tremor
Medications can both cause hand tremors and make them worse. If any of the following apply to you, your medication might be the cause of your shakiness:
You don’t have other conditions, like PD or hyperthyroidism, that can cause shakiness.
You notice your hands shaking shortly after taking the medication.
You noticed hand tremors started after your medication dose was raised.
The shakiness isn’t becoming worse — but it’s staying the same.
Tremors or twitching look the same on both sides (symmetrical).
Medications that can cause your hands to shake
While this is not a complete list, here are 10 common medications or types of medications that may give you shaky hands. If you take any of these medications and are experiencing shaky hands, talk to your healthcare provider. Don’t stop any medications without a provider’s OK.
1. Albuterol, salmeterol, and formoterol inhalers
Albuterol, salmeterol, and formoterol inhalers contain beta-agonist medications used for asthma and other lung conditions. Some well-known brands include:
Some of these medications can cause tremors in up to 20% of people who take them. But the risk of this side effect varies between medications. The risk of tremors becomes higher with larger doses.
These medications may cause tremors by activating the beta2-adrenergic receptors (binding sites) on muscle cells. But the tremors usually go away over time.
Amiodarone (Pacerone) is a heart medication used in people with arrhythmias (heart rhythm irregularities). This medication can cause neurotoxicity in up to 40% of people who take it. Neurotoxicity occurs when a substance damages or negatively affects the nervous system. Tremors are one of the symptoms of neurotoxicity, and they’re more likely to occur at higher doses.
Amiodarone may cause tremors by blocking dopamine, a naturally occurring chemical in the brain. Amiodarone-induced tremor may occur at any time after taking the medication and will usually resolve within 3 months after lowering or stopping the dose. Your risk of experiencing shaky hands goes down if you take 200 mg a day or less. But keep in mind that a lower dose may not be the right option for treating your condition.
3. Tricyclic antidepressants
Amitriptyline is a tricyclic antidepressant (TCA) that can be used to treat nerve pain, depression, and chronic headache.
TCAs can make natural tremors — called physiological tremors — more noticeable. These types of tremors are often unnoticeable and caused by natural rhythmic activities (e.g., heart beating) in your body. But this tremor usually goes away over time.
4. SSRI and SNRI antidepressants
Selective serotonin reuptake inhibitors (SSRIs), like fluoxetine (Prozac) and citalopram (Celexa), and serotonin and norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor), are commonly used to treat depression and anxiety.
They may cause hand tremors and twitching in 20% of people taking them by affecting naturally occurring chemicals in the brain. Stopping these medications too quickly can also cause tremors.
Medications that contain levothyroxine (Synthroid, Levoxyl) are used to treat hypothyroidism (low thyroid hormones). Thyroid hormones are necessary for important body functions like maintaining heart rate, weight, and digestion.
Taking too much levothyroxine can cause side effects that are similar to symptoms of hyperthyroidism. One of the most common symptoms of hyperthyroidism is tremors. If you begin experiencing shaky hands while taking levothyroxine, contact your healthcare provider. They may want to check your thyroid hormone levels.
Lithium is a mood stabilizer used to treat bipolar disorder and causes shaky hands in up to 65% of people who take it. Similar to amitriptyline, lithium is thought to exaggerate your natural or normal physiological tremor. Tremors will usually go away by lowering lithium doses or stopping the medication. But don’t stop your lithium without talking to your healthcare provider first.
7. Valproate (Valproic acid or Divalproex sodium)
Valproate (valproic acid or divalproex sodium) is commonly used for seizures, migraine prevention, and as a mood stabilizer. Almost 15% of people taking either valproic acid or divalproex sodium (Depakote) may develop tremors. It seems that women and older adults may be more likely to experience this side effect.
Valproate-related tremors might be linked to low levels of certain chemicals, like dopamine and norepinephrine. And these tremors tend to improve with beta-blockers, such as propranolol (Inderal). In fact, up to 24% of people with valproate-related tremors will need a beta-blocker to control their symptoms.
8. Metoclopramide and prochlorperazine
Metoclopramide (Reglan) or prochlorperazine are medications that might be used for nausea, and they can cause shaky hands by blocking dopamine receptors.
Lowering the dose or stopping these dopamine blockers might improve tremor symptoms. In one report with three study participants, taking propranolol also helped.
9. Immunosuppressants (cyclosporine and tacrolimus)
Cyclosporine (Sandimmune) and tacrolimus (Prograf) are immunosuppressants used in people who have received transplants as well as those with autoimmune diseases. Up to 40% of people taking cyclosporine may experience shaky hands and tremors since it might intensify your normal physiological tremor.
Tacrolimus also causes hand tremors. In a couple of small studies, between 20% to 40% of people with liver transplants experienced tremors with tacrolimus. This side effect doesn’t seem to be as common with people taking it for rheumatoid arthritis (RA). This might be because of neurotoxicity — similar to amiodarone.
Tacrolimus may also make your natural physiological tremor more noticeable. Because these medications are essential for preventing organ transplant rejection, you shouldn’t stop or change the dose of your medication on your own. If you believe you’re experiencing this side effect, discuss it with your healthcare provider.
10. Typical antipsychotics
Typical (first-generation) antipsychotics, like thioridazine and fluphenazine, are usually used for mental health conditions, such as schizophrenia. Up to 60% of people taking these medications may experience tremors. Similar to metoclopramide and prochlorperazine, typical antipsychotics cause tremors by blocking dopamine receptors.
Tremors may go away several months after stopping these medications. Switching to an atypical (second-generation) antipsychotic, like olanzapine (Zyprexa) or quetiapine (Seroquel), may also help. These newer antipsychotics are less likely to cause shaky hands or other tremors.
But if you need to keep taking a typical antipsychotic, your shaky hands may improve with amantadine (Gocovri, Osmolex ER) or benztropine.
How are medication-induced tremors different from Parkinson’s tremors?
There are two major types of tremors: resting tremors and action tremors.
These are typical of PD. Resting tremors with PD usually occur on one side of your body (asymmetric) and improve with motion. A Parkinson’s resting tremor typically occurs when the body part is relaxed and fully supported— like when your hand is resting on an armrest.
These make up the majority of tremors caused by medications. There are 5 types of action tremors, but we’ll focus on 2 common types: postural and kinetic.
Postural tremors happen when you’re holding a body part against gravity (e.g. when you’re holding your hands out in front of you).
Kinetic tremors happen when you’re performing a specific task or “goal-directed” movements — like when you’re reaching for something or touching your finger to your nose. Medication-induced tremors usually occur on both sides of your body.
Are shaky hands serious?
In short, no. Tremors and hand shaking aren’t usually serious.
But tremors in children might be serious and require a thorough assessment from your child’s pediatrician.
While having a tremor is typically a mild condition, shaky hands might make it difficult to perform daily or social activities, such as eating. For some people, however, tremors might be early symptoms of serious conditions, such as PD or Alzheimer’s disease (AD).
If you are concerned about shaky hands, talk with your healthcare provider. They can help you determine why they might be happening and come up with a treatment plan.
The bottom line
Tremors might be symptoms of serious medical conditions. But tremors might also be caused by medications. In many cases, as you continue to take your medication, the tremors will go away. In other cases, tremors will go away when your healthcare provider stops your medication or lowers the dose.
Having a tremor is usually a mild condition. But if you’re concerned about your tremors, talk with your healthcare provider. They can find ways to relieve your symptoms.
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